MDMA (ecstasy) toxicity: effects, dangers and emergency signs

NHS inform describes MDMA as the shortened chemical name for a synthetic psychoactive drug, which comes as powder or crystal and is the active ingredient expected in ecstasy pills. It is usually swallowed. Talk to FRANK explains that MDMA and ecstasy are the same drug and that ecstasy pills come in many colours and shapes, while the powder is sometimes called mandy or MD.

It is a stimulant that may increase feelings of empathy. Talk to FRANK says most people feel very happy, energised and alert, with intense perception of music and surroundings, and that effects usually last 2 to 4 hours, with some physical effects such as a fast heartbeat or insomnia persisting for a few hours afterwards.

NHS inform says you cannot be sure how you will react to MDMA or to a particular dose because everyone is different. Talk to FRANK says the amount of MDMA in ecstasy pills varies massively, and that some pills sold as ecstasy contain other, more dangerous drugs, some of which take longer to take effect, so people have taken more and overdosed. It adds that there is no way of knowing what is in a pill or powder until it has been taken, and that even testing kits may not find everything.

NHS inform draws the practical consequence: because other substances sold as MDMA may take longer to take effect, it advises waiting at least 2 hours before re-dosing, or avoiding re-dosing altogether.

Common short-term physical effects listed by NHS inform and Talk to FRANK include dilated pupils, a tingling feeling, tightening of the jaw muscles, raised body temperature, a faster heartbeat and nausea. Talk to FRANK says use of ecstasy has been linked to liver, kidney and heart problems, that high doses can be deadly, whether or not with other drugs, and that anyone with a heart condition, blood pressure problems, epilepsy or asthma can have a very dangerous reaction.

Some people also report anxiety, panic attacks, confused episodes, paranoia and even psychosis after taking ecstasy, according to Talk to FRANK. Some users feel low the next day, an after-effect known as a comedown, which can last for several days.

Talk to FRANK says ecstasy affects the body's temperature control. Dancing for long periods in a hot atmosphere increases the chance of overheating and dehydration, and people who have taken it might not realise they are in danger. It advises regular breaks to cool down and watching out for friends, and says that during heatwaves and festivals it is especially important to stay cool and hydrated.

The opposite problem also exists. NHS inform advises aiming to drink about half a pint (284 mL) of water per hour and says to avoid drinking too much water. Talk to FRANK says users should sip no more than a pint of water or non-alcoholic drink every hour, and that drinking too quickly might affect the body's salt balance, which can be as deadly as not drinking enough water.

NHS inform says to avoid taking MDMA with other drugs, including alcohol and certain medicines. It warns that selective serotonin reuptake inhibitors (SSRIs) and some other medicines for mental health conditions can dull the euphoria, which may tempt people to take more, putting more strain on the body and increasing the risk of a serious condition called serotonin syndrome. Talk to FRANK similarly says mixing drugs is always risky, and that some mixtures are more dangerous than others.

NHS inform advises people to look after each other and watch for anyone having an adverse reaction. It says to phone 999 or go to A&E if there is overheating, fitting, disorientation, agitation, confusion or becoming rigid. Talk to FRANK says that if someone needs urgent help after taking drugs, call 999 for an ambulance and tell the crew everything you know, because it could save their life.

Telling the crew what was taken, and when, helps them treat the person's condition.

NHS inform says that with repeated use MDMA depletes serotonin, a hormone that regulates mood and feelings of wellbeing, and that over time this may increase the risk of experiencing anxiety and depression. Talk to FRANK says evidence suggests long-term users can suffer from memory problems and may develop depression and anxiety.

On dependence, Talk to FRANK says people can build up tolerance, needing more of the drug for the same effect, and may develop a psychological dependence, a strong desire to keep using even when it is causing harm. Support is available through GPs and local drug services, and NHS inform signposts people to find local alcohol and drug services.

Talk to FRANK says possession is punishable by up to 7 years in prison, an unlimited fine or both, and that supplying, even to friends, can bring life in prison. It also warns that driving when high is dangerous and illegal. NHS inform points to information on support for people affected by drugs and to a Scottish service directory for local alcohol and drug services.

A GP or local drug and alcohol service can help anyone who wants to cut down or stop, or who is worried about mental health after using. If you are worried about someone, Talk to FRANK has guidance for people concerned about a friend or child.

Emergency treatment for MDMA toxicity is provided by the ambulance service and A&E, and drug treatment and mental health support are available through the NHS and local authority commissioned services. Private addiction and psychiatric services exist, and some people use them for residential programmes or therapy. In both settings the first priority after a serious reaction is medical stabilisation, followed by follow-up for liver, kidney, heart and mental health problems.